TMR Non-Drug Therapy 2018 June; 1(2): 28-40

Review

Acupuncture as a potential approach to improving the health of women with obesity

Fung-Kei Cheng1 *

1
New Territories, Hong Kong.

*Correspondence to: Fung-Kei Cheng, New Territories, Hong Kong. Email: oasischeng@yahoo.com.

Highlights Editor’s Summary

This review recommends an integrative approach of
acupuncture in combination with other therapeutic
strategies in the weight management of women with
obesity and the treatment of adiposity-incurred
illnesses.
This literature review analyses 25 clinical studies,
involving 2407 participants aged 13-65 in Africa,
Asia, the Middle East, and North America, offering
recommendations for the reliability and validity of
acupuncture in the treatment of women’s obesity
and adiposity-incurred illnesses.

Citation: Cheng FK. Acupuncture as a potential approach to improving the health of women with obesity. TMR
Non-Drug Therapy 2018, 1(2): 28-40.
DOI: 10.12032/TMRND201801006
Submitted: 7 May 2018, Accepted: 18 May 2018, Online: 6 June 2018.

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 TMR Non-Drug Therapy 2018 June; 1(2): 28-40

Abstract
In addition to higher risks of various obstetric and gynaecological illnesses among women with obesity or who are
overweight, maternal adiposity threatens the lifetime health of their offspring. Diverse treatments are provided, including
complementary and alternative medicine such as Chinese medical practices. Acupuncture, a traditional Chinese
medicinal method, is increasingly being applied to this health problem. This literature review analyses 25 clinical studies,
involving 2407 participants aged 13-65 in Africa, Asia, the Middle East and North America. This illustrates the use of
acupuncture alone or with other approaches to control body weight, obesity-induced diseases, and gynaecological health.
Although positive indicators are presented, this study offers recommendations for enhancing reliability and validity in
further research. It therefore suggests the use of acupuncture in dealing with obesity due to its efficacy, and economic
and safety benefits.
Keywords: Acupuncture-complementary and alternative therapy, Adiposity, Chinese medicine, Narrative review,
Obstetrics and gynaecology, Weight loss

摘要

肥胖或超重的妇女除了患各种产科和妇科疾病的风险更高之外，产妇的肥胖也威胁着她们下一代的
健康。对此有不同的治疗方法，包括补充和替代医学，例如中医治疗。针灸作为一种传统的中医疗法，
被日渐广泛应用于这一类健康问题的治疗中。该综述回顾性地分析了25项临床研究，包括2407名年龄在
13岁至65岁，来自非洲、亚洲、中东和北美的参与者，说明针灸被单独使用或与其他方法联合使用，来
控制体重、治疗肥胖引起的疾病和妇科健康问题体现了积极的治疗效果。本研究也为进一步研究的可靠
性和有效性提供了建议。因此，鉴于针灸治疗具有疗效积极、经济和安全的优势，建议使用针灸治疗肥
胖。
关键词：针灸辅助疗法；肥胖；中医药；叙述性文献综述；妇产科；减肥

Abbreviations: BMI, Body mass index; TC, Total cholesteroal; TG, Triglycerides; LDL-C, Low density lipoprotein
cholesterol; HDL-C, High density lipoprotein cholesterol.
Competing interests: The authors declare that there is no conflict of interests regarding the publication of this paper.
Copyright: © 2018 TMR Publishing Group Limited. This is an open access article distributed under the terms of the
Creative Commons Attribution Non Commercial License.
Executive Editor: Nuoxi Pi, Chang Liu.

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Introduction
A rapid prevalence of obesity and being overweight will
probably increase to around 20% and 38% of the
worldwide adult population respectively by 2030 [1]. It
has become the fifth leading risk of death, involving over
2.8 million adults globally every year [2]. Furthermore,
more women tend to become obese than men, while the
reverse occurs for those who are overweight [3]. Obesity
is defined as adiposity, or excessive body fat
accumulation indicated by body mass index (BMI).
However, the index varies among regional statistics:
North American adults with a BMI of 25 or over are
classified as overweight, with a BMI of at least 30
indicating obesity; the respective BMI for Asians are 23
and 25; are 26 and 32 correspondingly for Pacific
Islanders [4-5]. Obesity largely results in biological,
environmental, and lifestyle influences [6-8].
Obesity threatens women’s physical health, incurring
chronic illnesses. For instance, diabetes, stroke, and
cardiovascular diseases [9-12]. Furthermore, it also
causes gynaecological diseases such as breast cancer,
polycystic ovary syndrome, menopausal symptoms,
menstrual irregularity and dysmenorrhea [13-18]. Equally
worrying are mental disorders, for example, depression,
which are not rare among obese women [19-20]. These
perils result in a shorter life expectancy and significantly
higher health costs [21-22]. Research also raises the
alarm that maternal obesity not only induces miscarriage
or peri-natal complications more easily, which causes
anxiety in pregnant women, but also affects long-term
infancy health among foetuses, and from juveniles to
adults, and includes adolescent cardiovascular diseases
and autism [23-27].
Sophisticated strategies are offered for obesity
management [28]. Pharmacy is usually used in reducing
weight for obese women and even pregnant women who
are overweight or obese, and even bariatric surgery is an
option [29-31]. However, side effects limit the
effectiveness of these treatments [32]. Thus, non-intrusive
interventions are recommended in adopting mental
imagery, cognitive-behavioural therapy and lifestyle
adjustments [33-35]. Diet control, such as low-calorie and
vegetarian diets, can also contribute to weight loss [36].
Physical exercise and dance movement therapy are
likewise effective in weight reduction [37-40]. Apart from
the above, complementary and alternative therapy further
contributes to anti-obesity measures, for instance,
caraway, and acupuncture [41-43].
Acupuncture, a traditional Chinese medical practice,
has been employed for more than 3,000 years. The
earliest monograph of acupuncture in China is in
Zhenjiujiayijing (215-282, A.D. Jin Dynasty), which
records the use of acupuncture before Jin dynasty and the
experience of acupuncture treatment at that time [44]. It is
a healing method that consists of inserting a needle into
one or more acupoints (specific simulation points) out of
365 in 14 meridians along the body, in duration from
seconds to minutes in order to activate Qi (energy flow)
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TMR Non-Drug Therapy 2018 June; 1(2): 28-40
[45-46]. Individuals who are receiving this approach may
feel sore, full, a dull pain, aching, numb, warm, and / or
heavy, indicating De-Qi (energy arrival) which presents
responses in the autonomic system, limbic and
para-limbic system, and neo-cortical structure of the brain
[47-49]. Functions include stimulation of neuro-chemical
release, blockage of pain signals, and generation of
cellular and molecular components [50]. Recent studies
report positive indicators for a spectrum of physical and
psychological disorders such as sciatica, tinnitus, immune
modulation, and addictive behaviours [51-54]. Evidence
shows acupuncture is inexpensive and safe with very few
adverse effects even for children, the elderly, or pregnant
women [55-61]. Use of this intervention for women’s
health is growing [62].
Acupuncture has been developed for diverse practices.
Auricular acupuncture utilises the theory that reflex
points on the ear stimulate corresponding body parts [63].
With the aid of advanced technology, electro-acupuncture
and laser acupuncture have also been developed [64-65].
Acupuncture always combines with other Chinese
treatment measures. Cupping is applied on the skin over
specific acupoints by a thinned air glass to produce a
partial vacuum resulting from heat inside a glass, to
conduct treatment through hyperaemia or homeostasis
[66]. Massage is the systematic rubbing of muscle,
exerting heat to enrich the veins, lymph vessels, and
nerve activity [67]. Chinese herbs have obvious efficacy
for diseases [68]. Moxibustion uses a burning moxa stick
to generate warmth on acupoints, which when combined
with acupuncture couples to form a warming acupuncture
[69-70].
In analysing the usefulness of acupuncture in coping
with obesity that looms over women’s health, this
literature review offers an overview of the outcomes
demonstrating how this method can be employed alone or
with other approaches. It provides choices, such as
adjunct therapy, to patients and medical care
professionals.
Research method
This review adopts 27 major electronic databases from
ProQuest, including Biological Sciences, British Nursing
Index, MEDLINE, PsycARTICLES, and PsycINFO, by
inputting the keywords “acupuncture”, “woman” and
“obesity or weight control or weight loss”. Twenty-nine
works were listed. Additionally, two Chinese databases -
the China National Knowledge Infrastructure and Taiwan
Electronic Periodical Services - were searched, by keying
in “ 针 灸 ”, “ 女 ” and “ 肥 胖 or 痴 肥 or 减 肥 ”,
enumerating 62 works. The inclusion criteria selected
clinical human-based studies of acupuncture, and full
texts (including online first publications) published prior
to May 2017 in peer-reviewed, scholarly journals.
However, duplications, literature reviews, book reviews,
dissertations, editorials, and commentaries were
excluded.
Findings and discussion
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In accordance with the eligibility criteria, 25 projects (n = Korea, Taiwan, Thailand, Turkey, Sudan, and the USA
11 in English, n = 14 in Chinese) were reviewed, (refer to Table 1).
covering 2407 women, aged 13-65, in China, Egypt,
Table 1 Analysis of the reviewed 25 studies

Method design
Research
Source Research Sample size Intervention Results
location
objective(s)
To investigate
Reductions in body weight,
Li S, Li P, the effects of
30 women, 30-minute session, BMI, abdominal subcutaneous
Ruan L, et abdominal Sudan
aged 15-50. total 80 sessions. fat thickness, and prehepatic fat
al. [71] acupuncture on
thickness.
obesity.
Randomly assigned
To examine the 62
Hung YC, to laser acupuncture
effects of laser postpartum
Hung IL, (n = 32), and control Reductions in body weight,
acupuncture on women. Taiwan
Hu WL, et (n = 30) groups. BMI, body fat percentage.
postpartum Unspecified
al. [72] 5-second session,
weight control. age range.
total 12 sessions.
Distributed to the
Effect rate: 89.5% in
acupuncture with
To compare the acupuncture with diet and
massage, cupping,
effects of exercise group, 52.6% in diet
diet and exercise (n
Wang JH, acupuncture and 38 postnatal and exercise group.
= 19), and diet and
Liu J, Xu other adjunct women, More significant reductions in China
exercise (n = 19)
X [73] therapies on aged 25-40. body weight, and BMI in
groups.
post-natal acupuncture with diet and
30-minute session,
obesity. exercise group than that in diet
unspecified total
and exercise group.
sessions.
Randomly allocated
To compare the to the acupuncture
effects of with metformin (n =
Reductions in body weight,
acupuncture with 50, aged 22-38), and
BMI, waist-hip ratio, and size of
metformin and metformin alone (n
100 obese cystic ovary.
Zhang ZL metformin alone = 50, aged 23-37)
women, A decrease in hormones. China
[74] on obese patients groups.
aged 22-38. More significant indicators in
with infertility 30-minute session, 6
acupuncture with metformin
caused by months; unspecified
group.
polycystic ovary total sessions.
syndrome. Metformin: 3 times
a day, 6 months.
Randomly
To assess the distributed to the
He J, effects of acupuncture (n = 20)
56 women.
Zhang X, acupuncture and and acupuncture
Unspecified Reductions in body weight. China
Qu Y, et acupuncture with with massage (n =
age range.
al. [75] massage on body 20) groups.
weight loss. 30-minute session,
total 21 sessions.
Randomly assigned Effect rate of weight loss:
To assess the to the warming 95.2% in warming acupuncture
effects of acupuncture and ear and ear acupuncture group,
Lu C, Liu warming acupuncture (n = 63, 82.5% in warming acupuncture
126 women,
Z, Xu B acupuncture and aged 17-62), and group. China
aged 17-62.
[76] ear acupuncture warming Reduction in lipid: 93.7% in
on obesity with acupuncture (n = 63, warming acupuncture and ear
hyperlipidemia. aged 18-56) groups. acupuncture group, 81% in
30-minute session, warming acupuncture group.

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 TMR Non-Drug Therapy 2018 June; 1(2): 28-40

Method design
Research
Source Research Sample size Intervention Results
location
objective(s)
unspecified total Reductions in BMI, degree of
sessions. obesity, body fat percentage,
and waist circumference.
Decreases in serum TC, TG, low
LDL-C.
An increase in HDL-C.
Randomly
Effect rate: 95.4% in the
distributed to the
acupuncture and ear
To examine the warming
acupuncture group, 84.6% in
effects of acupuncture and ear
acupuncture group.
Pang Z, warming acupuncture (n = 65,
130 women, Reductions in body weight,
Liu Z, Xu acupuncture and aged 19-54), and China
aged 18-54. BMI, degree of obesity, body fat
B [77] ear acupuncture warming
percentage.
on obesity with acupuncture (n = 65,
Decreases in serum TC, TG,
hyperlipidemia. aged 18-54) groups.
LDL-C.
30-minute session,
An increase in HDL-C.
total 45 sessions.
To investigate Effect rate: 95.5%.
Zhang Q, the effect of Reductions in body weight,
Duan W, electro-acupunct 67 women, 30-minute session, BMI, chest circumference, waist
China
Li N, et al. ure on obesity aged 16-58. total 45 sessions. circumference, hip
[78] with breast circumference, thigh
hyperplasia. circumference, waist-hip ratio.
Effect rate of obesity: 88.4%.
To investigate Reductions in body weight,
the effects of BMI, body fat, and degree of
warming obesity.
Liu H, Liu 91 women, 30-minute session,
acupuncture on Effect rate of menopause: China
T [79] aged 43-54. total 36 sessions.
obesity among 99.1%.
menopausal Significant reductions in
women. Kupperman menopausal index,
follicle-stimulating hormone.
To examine the
Set T,
effects of ear 24 women, 15-20 minutes per
Cayir Y, No reduction in BMI and
acupuncture on unspecified session, total 6 Turkey
Pirim depression.
the obese women age range. sessions.
ABG [80]
with depression.
Randomly
To investigate
distributed to the
the effects of
acupuncture (n = Reductions in body weight,
Yang YC, acupuncture on
23), and sham BMI, waist circumference.
Kim JI, heart rate 46 women,
acupuncture (n = 23) Deactivation of parasympathetic Korea
Kim KW, variability in aged 21-54.
groups. function and an increase in
et al. [81] obese
30-minute session, sympathetic activity.
premenopausal
unspecified total
women.
sessions.
Effect rate (10 sessions): 97.7%
Divided into the in dysmenorrhea group, 72.7%
To examine the 87 women
dysmenorrhea (n = dysmenorrhea with obesity
effects of with
44, aged 18-45), and group.
warming primary
Ren B dysmenorrhea with Effect rate (20 sessions): 100%
acupuncture and dysmenorrh China
[82] obesity (n = 43, aged in dysmenorrhea group, 86%
ear acupuncture ea.
17-44). dysmenorrhea with obesity
on dysmenorrhea Unspecified
30-minute session, group.
with obesity. age range.
total 90 sessions. Effect rate (30 sessions): 100%
in dysmenorrhea group, 88.4%

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 TMR Non-Drug Therapy 2018 June; 1(2): 28-40

Method design
Research
Source Research Sample size Intervention Results
location
objective(s)
dysmenorrhea with obesity
group.
To look into the
effects of
acupuncture and
Effect rate: 87.8%.
Cao X, ear acupuncture
131 women, 30-minute session, Reductions in body weight,
Liu Z, Xu with moxibustion China
aged 16-50. total 45 sessions. BMI, body fat percentage.
B [83] on obesity with
The younger, the more effective.
pre-menstrual
tension
syndrome.
Güçel F, 20-minute session,
To examine the
Bahar B, 40 women. total 10 sessions.
effects of
Demirtas Unspecified Acupoints: LI4, Reduction in body weight. Turkey
acupuncture on
C, et al. age range. HT7, ST36, ST44,
weight loss.
[84] SP6.
The laser groups receiving 358
Divided into 1
and 597 J/cm2 showed
placebo group, and 3
significant reductions in body
groups with
weight, BMI, body fat mass,
different levels of
waist girth, hip girth and
laser (358, 478, and
waist-hip ratio after treatment
Liu XG, To investigate 597 J/cm2; powers:
28 female compared with the placebo
Zhang J, the effects of 150, 200, and 250
students, group. The percent reductions of China
Lu JL, et laser acupuncture MW; intensity:
aged 19-25. body fat mass in the laser
al. [85] on obesity. 1194, 1592, and
groups receiving 358 and 597
1990 MW/cm2;
J/cm2 were 4.29% and 3.94%,
irradiation time: 5
respectively, and the
min/point, 25 min in
corresponding values of body
total).
weight were 1.99% and 1.63%,
Total 24 sessions.
respectively.
To look into the
Reductions in body weight,
effects of
BMI, body fat percentage, and
Ren B, acupuncture and 151 obese
30-minute session, obesity index.
Liu Z, Xu moxibustion on women, China
total 45 sessions. Reduction in climacteric
B [86] obese women aged 45-55.
syndrome: 98.7%.
with climacteric
Reduction in obesity: 85.5%.
syndrome.
Randomly Higher reductions in body
distributed to weight, BMI, waist
To compare the
electro-acupuncture circumference, hip
effects of
and ear acupuncture circumference, waist-hip ratio,
Rerksuppa electro-acupunct
29 women, (n = 16), and ear triceps skinfold thickness,
phol L ure and ear Thailand.
aged 21-60. acupuncture (n = 13) subscapular thickness, mid arm
[87] acupuncture and
groups. circumference in
acupuncture
30-minute session, electro-acupuncture and ear
alone on obesity.
unspecified total acupuncture group than in ear
sessions. acupuncture group.
To examine the Randomly assigned
effects of to the acupuncture
electro-acupunct with medicinal 92.9% in acupuncture with
Zhang X,
ure and 58 women, moxibustion (n = 28, medicinal moxibustion group,
Tang X, Li China
medicinal aged 35-65. aged 35-62), and and 70% in electro-acupuncture
W [88]
moxibustion on electro-acupuncture group.
obesity due to (n = 30, aged 37-65)
spleen and groups.

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 TMR Non-Drug Therapy 2018 June; 1(2): 28-40

Method design
Research
Source Research Sample size Intervention Results
location
objective(s)
kidney yang 40-minute
deficiency. acupuncture with
moxibustion per
daily session, total
15 sessions.
Effect rate: 95.1% on weight
loss, 100% on menstrual pain.
Reductions in weight, BMI,
degree of obesity, body fat
percentage, and menstrual pain.
To investigate
The younger, the more effective
the effects of 102 obese
on weight loss.
Shi W, Liu acupuncture and women with 30-minute daily
Effect rate after 10 sessions:
Z, Xu B ear acupuncture dysmenorrh session, total 30 China
81.4% on weight loss, 92.2% on
[89] on obese women ea, aged sessions.
menstrual pain.
with 18-49.
Effect rate after 20 sessions:
dysmenorrhea.
92.2% on weight loss, 100% on
menstrual pain.
Effect rate after 30 sessions:
97.1% on weight loss, 100% on
menstrual pain.
To test the effects
Yang YD, of acupuncture 45-60 minutes
38 women,
Zhang and Chinese session, total 15 Effect rate: 94.7%. China
aged 16-51.
YM [90] medicine on sessions.
obesity.
Abd KS, To investigate 20 obese
Kosery the effects of postmenopa
30-minute session, Reductions in BMI, waist-hip
SM, electro-acupunct -usal Egypt
total 24 sessions. ratio, and body fat percentage.
Shamy FF, ure on body fact women,
et al. [91] composition. aged 50-60.
To compare the Divided into the Effect rate of obesity: 96.1% in
effects of acupuncture (n = acupuncture, 69.4% in Chinese
acupuncture and 108 obese 54), and Chinese medicine.
Gao X
Chinese women, medicine (n = 54) Effect rate of menopausal China
[92]
medicine on aged 40-55. groups. syndrome: 82.4% in
perimenopausal 30-minute session, acupuncture, 84.7% in Chinese
obesity. total 30 sessions. medicine.
Divided into the
obesity (n = 407,
To investigate
808 obese aged 16-44), and Effect rate: 96.3% in obesity
the effects of
women with obesity with group, 89% in obesity with
acupuncture and
Xu Y [93] dysmenorrh dysmenorrhea (n = dysmenorrhea. China
ear acupuncture
ea, aged 401, aged 13-50) Reduction in dysmenorrhea:
on obesity with
13-50. groups. 89%.
dysmenorrhea.
30-minute session,
total 45 sessions.
To examine the Randomly No significant reductions in
Hsu CH, effects of ear distributed to ear body weight, BMI, waist
Wang CJ, acupuncture on 45 obese acupuncture (n = circumference in both groups.
Hwang obesity, and women, 23), and sham ear A significant increase in ghrelin Taiwan
KC, et al. obesity-related aged 16-65. acupuncture (n = 22) level and decrease in leptin level
[94] hormone groups. in ear acupuncture group but not
peptides. Total 12 sessions. in sham ear acupuncture group.
Cabioglu To compare the 55 women, Allocated to the no 4.8% of weight loss in
Turkey
MT, effects of aged 35-50. treatment (n = 12), electro-acupuncture, and 2.5%

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Method design
Research
Source Research Sample size Intervention Results
location
objective(s)
Ergene N electro-acupunct electro-acupuncture in diet groups.
[95] ure and diet (n = 22), and diet Significant decreases in TC and
control on weight control (n = 21) TG levels in electro-acupuncture
loss and groups. and diet groups.
anthropometric 30-minute session, LDL-C in the
indicators. total 20 sessions. electro-acupuncture group.
No significant changes could be
found in HDL-C levels among
the three groups.

Note: BMI, Body mass index; TC, Total cholesteroal; TG, Triglycerides; LDL-C, Low density lipoprotein cholesterol;
HDL-C, High density lipoprotein cholesterol

Thirty Sudanese women, aged 15-50 years old, who
experienced 30-minute acupuncture sessions for 80
treatments, reduced their body weight, BMI, abdominal
subcutaneous fat thickness, and prehepatic fat thickness;
although an earlier study found no effects after using ear
acupuncture in 45 women for 12 sessions [71, 94]. Laser
acupuncture at 358 and 597 J/cm2 for 24 sessions showed
the highest efficacy towards improvements in body
weight, BMI, body fat mass, waist girth, hip girth, and
waist-hip ratio [85]. Rerksuppaphol looked into how to
combine electro-acupuncture and ear acupuncture to
manage excess fat accumulation, decreasing body weight,
BMI, waist circumference, hip circumference, waist-hip
ratio, triceps skinfold thickness, subscapular thickness,
and middle arm circumference [87]. Moreover, many
attempts at using other methods with acupuncture also
substantiated the effects on obesity; for example, with
massage, Chinese herbs, electro-acupuncture and
moxibustion, and diet management [75, 88, 90, 95].
Notwithstanding, each of these projects included a small
number of individuals (less than 60).
While obesity with comorbidity is common,
acupuncture is adopted to cope with these conditions,
within which obstetrics and gynaecology are inseparable
within various lifespan phases among women.
Hyperlipidaemia
Obesity-related hyperlipidaemia (high levels of
cholesterol and triglycerides) harms people’s health.
Adiposity is connected with hyperlipidaemia, a low level
of high density lipoprotein cholesterol (HDL-C), and a
high level of low density lipoprotein cholesterol (LDL-C),
frequently linking to diabetes and hypertension [96-100].
Pang and colleagues recruited 130 participants who were
18-54 years old to compare the effects of warming
acupuncture and ear acupuncture on obesity with
hyperlipidaemia [77]. The women were randomly and
evenly allocated to these two groups. The warming
acupuncture group underwent 45 sessions for 30-minute
each time, showing an effect rate of 95.4%, compared
with 84.6% in the ear acupuncture group. This efficacy
encompassed reductions in body weight, BMI, degree of
obesity, body fat percentage, decreases in serum total
cholesteroal (TC,) triglycerides (TG), LDL-C, and an
increase in HDL-C. This study was supported by another
project with 126 women aged 17-62 [76].
Breast hyperplasia
Breast hyperplasia is connected with benign lesions or
cancer [101]. Electro-acupuncture was applied to 67
obese women with breast hyperplasia, aged 16-58, who
received 45 sessions for 30-minute each time [78]. 95.5%
of the participants saw a reduction in body weight, BMI,
circumferences of chest, waist, hip, thigh and waist-hip
ratio. However, a control group was absent to detail a
fuller picture of the outcomes.
Polycystic ovary syndrome
Obesity linked with polycystic ovary syndrome increases
infertility rates [102]. One 6-month study compared the
effectiveness of between acupuncture and acupuncture
with metformin (medication) on 100 young obese women
(22-38 years old) who suffered from polycystic ovary
syndrome [74]. The participants were randomly
distributed to acupuncture with metformin (n = 50) and
metformin alone (n = 50) groups. They took the drug
thrice a day. Each acupuncture session lasted 30 minutes.
Both groups reported decreases in hormones, the size of
cystic ovaries, body weight, BMI, and waist-hip ratios,
while the mixed method group gained more significant
improvements.
Pre-menstrual tension syndrome
Adiposity feasibly induces pre-menstrual tension
syndrome (for instance, headaches, irritable feeling, and
mood swings), through negative impacts on changes in
hormones and neurochemicals [103]. A combination of
acupuncture, ear acupuncture, and moxibustion was used
for 131 women with pre-menstrual tension syndrome,
ranging from 16-50 years old, who completed 45 sessions
for 30-minute each [83]. The effect rate reached 87.8%, in
which the participants observed reductions in body
weight, BMI and body fat percentages and improvements
in mood problems. Also, the younger women showed
more effective results.

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Table 2 Results of acupuncture for dysmenorrhea
Number of sessions Effect rate on obesity in normal weight
women with dysmenorrhea
10 97.7%
20 100%
30 100%
Table 3 Results of the 102 participants
Number of sessions Weight loss
10 81.4%
20 92.2%
30 97.1%
Dysmenorrhea
Dysmenorrhea (menstrual cramp) can occur among both
underweight and overweight women [104]. Ren
investigated how warming acupuncture and ear
acupuncture can alleviate primary dysmenorrhea [82].
Eighty-seven participants, including 44 normal weight
women with dysmenorrhea and 43 obese women with
dysmenorrhea, took 90 sessions for 30 minutes each.
They highlighted the association of treatment outcomes
and number of treatments (refer to Table 2)
Having undergone 30 body and ear acupuncture
sessions for 30 minutes each, 95.1% of 102 participants
achieved weight loss, and decreased BMI, body fat
percentages, and degrees of obesity, together with 100%
experiencing diminished menstrual pain [89]. They
reported the relationship between sessions taken and
effectiveness (Table 3), and depicted the result among the
younger women, the better effect rate. These outcomes
were also underpinned by another 808 women who were
13-50 years old [93].
Post-natal obesity
Postpartum weight retention may last one year after
delivery and is associated with a higher possibility of
obesity [105]. Laser acupuncture was applied to 32
postpartum women, who reported decreases in body
weight, BMI, and body fat percentages [72]. Excessive
weight gain in post-natal mothers may accompany lower
breastfeeding rates, which increases the number of obese
children, caused by the inverse correlation between
breastfeeding and infant obesity [106-107]. Wang and
colleagues led a comparison study to evaluate the effects
of acupuncture and other complementary and alternative
therapies on tackling post-natal obesity [72]. Thirty-eight
post-natal informants (25-40 years old) were equally
divided into two groups: one in which the participants
received 30-minute acupuncture sessions, massage,
cupping, diet control, and physical exercise, and another
for diet and exercise only. The overall effect rate was
shown to be 89.5% in the former group and 52.6% in the
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TMR Non-Drug Therapy 2018 June; 1(2): 28-40
Effect rate on obesity in obese
women with dysmenorrhea
72.7%
86%
88.4%
Reduction in menstrual pain
92.2%
100%
100%
latter. However, such a small sample size results in a lack
of sufficient data, especially without a control group.
Menopause
Menopause-based health problems are experienced across
different stages of menopause due to a loss of estrogen, or
to other hormonal changes [108]. Although most women
have no apparent symptoms during their premenopausal
period, some will encounter overeating, bloating, and
irritability. Forty-six premenopausal women between 20
and 54 years old were randomly assigned to acupuncture
(n = 23) and sham acupuncture (n = 23) groups,
deactivating the parasympathetic function and increasing
sympathetic activity [81]. Gao worked with 108 obese
women who were in peri-menopause (aged 40-55) [92].
After undergoing 30 sessions for 30-minute each of
acupuncture, 96.1% experienced weight loss and 82.4%
saw a decrease in menopausal syndrome. Another 91
women, aged 43-54, reported significant decrease in
Kupperman menopausal index (an assessment tool for
climacteric symptoms) and follicle-stimulating hormone
[79]. They completed 36 warming acupuncture sessions,
following which 88.4% delineated diminished body
weight, BMI, and degrees of obesity, and 99.1% realised
an abatement in climacteric syndrome. Congenial results
were presented in a separate study with 151 individuals
aged 25-55 who accepted a mixed treatment of
acupuncture and moxibustion [86]. Electro-acupuncture
was used in 20 post-menopausal women (50-60 years old),
showing declines in BMI, waist-hip ratios, and body fat
percentages after 30 treatments over 12 weeks [91].
Again, further research with a larger sample population is
necessary for richer evidence.
Depression
Research has demonstrated a direct correlation between
being overweight and mood disorders; for instance,
suffering from depression [109-110]. In contrast, little
improvement was shown in obesity and depression for 24
participants [80]. Although this was an encouraging trial
TMR Non-Drug Therapy | June 2018 | vol. 1 | no. 2 | 36

in Turkey, its small number of participants, no control
group, and limited treatment sessions (n = 6) affected the
outcomes.
Recommendations
Women with obesity suffer from not only adiposity-led
illnesses but also obstetric and gynaecological diseases,
for which the reviewed 25 studies illustrate positive signs
for coping with these threats through acupuncture. This
improves women’s health across different phases of their
lifespan. However, enhancements in research design are
essential to increase the reliability.
Even though there are nine randomised controlled trials,
many of them have insufficient description of how the
randomisation was processed, how acupuncture was
applied, or the limitations of the research design. These
details are necessary for replication, not only for clinical
purposes but also scientific research, which help optimise
the use of acupuncture in obesity and its related issues.
Out of the reviewed 25 studies, there is only one
project which conducted follow-up, thus they all illustrate
merely the short-term effects of acupuncture. This review
proposes long-term research to substantiate acupuncture
in the long-run and gain more in-depth investigation
[111].
Twelve studies (48%) were carried out with a small
sample size of less than 60 participants. Such a pitfall is
unable to satisfy the requirements of convincing research.
This review suggests that future projects be conducted
with a larger number of participants to strengthen data
reliability in the empirical research.
Combined treatments in the reviewed studies showed
the efficacy of using acupuncture and other methods in
overweight conditions or obesity; therefore, this review
recommends an integrative approach. For example, in
combination with physical activities, and food choices.
Physical exercise plays a vital role in weight control by
consuming energy, regulating food intake, and modifying
sedentary behaviour [112]. It can also be conducive to
better health-related qualify of life and accommodate
even pregnant women under guidance [113]. In addition,
healthy eating is a common cornerstone of weight
management and general health [114-115].
Conclusion
This literature review delves into the usefulness of
acupuncture, either alone or with other methods, in
managing obesity, and treating related health problems
and obstetric and gynaecological challenges, involving
over 2,400 females from 13-65 years old in China, Egypt,
Korea, Taiwan, Thailand, Turkey, Sudan, and USA. The
reviewed 25 studies give encouraging indications; thus,
this research suggests the adoption of acupuncture, by
itself alone or with other therapeutic strategies, as an
adjunct therapy to ameliorate women’s health.
Nevertheless, there is room for improvements in future
research for carrying out scientific projects.
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TMR Non-Drug Therapy 2018 June; 1(2): 28-40
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